PREDICTORS OF RECURRENCE OF FULMINANT BACTERIAL PERITONITIS AFTER DISCONTINUATION OF ANTIBIOTICS IN OPEN MANAGEMENT OF THE ABDOMEN

Objective: To assess a scoring system for predicting recurrence of ful minant bacterial peritonitis after discontinuation of antimicrobial tr eatment in patients being treated by open management of the abdomen fo r persistent bacterial peritonitis after perforation of the digestive tract, anastomotic disruption, or necrotising pancreatitis. Design: Re trospective study. Setting: University Hospital, The Netherlands. Subj ects: 58 consecutive patients. Main outcome measurements: Recurrence o f fulminant bacterial peritonitis and survival. Results: 13 of the 58 patients (22%) died during the initial course of antimicrobial drugs. 14 of the remaining 45 patients had a recurrence of fulminant bacteria l peritonitis after discontinuation of antimicrobial drugs, 4 of whom died. Predictive criteria included raised white cell count (WCC) (p = 0.02), duration of initial antibiotic treatment (p = 0.05), and deteri oration in Simplified Acute Physiology Score (p = 0.05). Using the WCC and the duration of initial antimicrobial treatment together with oth er variables that showed a predictive trend (body temperature, percent age band cells, underlying disease, and use of inotropic agents), in a new scoring system (0-12), fulminant bacterial peritonitis did not re cur when the score was 0-3, but in 9 of II patients with a score of 6 or more it did (p < 0.001). Conclusion: Patients at increased risk of recurrence of fulminant bacterial peritonitis during open management o f the abdomen can be identified at the time of discontinuation of anti microbial treatment by a new scoring system; antimicrobial treatment s hould not be discontinued in patients with a score of 6 or more.